Guidelines issued to help end deaths from postpartum haemorrhage
New guidelines from WHO, FIGO and ICM aim to revolutionise the prevention, diagnosis and treatment of postpartum haemorrhage (PPH), a leading cause of maternal mortality.
Based on a major Lancet study, the guidelines introduce objective diagnostic criteria.
They also recommend the E-MOTIVE bundle for immediate action, aiming to save lives and reduce global health disparities.
On October 5, 2025, leading reproductive health organisations issued new guidelines advocating for significant changes in the prevention, diagnosis and treatment of postpartum hemorrhage (PPH).
The guidelines were published by the World Health Organization (WHO), the International Federation of Gynecology and Obstetrics and the International Confederation of Midwives. They introduce new objective diagnostic criteria for detecting PPH.
The advisory document was based on the largest study on the topic published in The Lancet on October 4, 2025.
Although deaths related to postpartum haemorrhage have been nearly eliminated in high-income countries, they remain disproportionately high in low-income and lower-middle-income countries, especially in sub-Saharan Africa and South Asia.
The objective of The Lancet study was to evaluate how accurately clinical indicators of postpartum bleeding can predict maternal death or severe morbidity.
The researchers found that "measured blood loss below the conventional threshold, combined with abnormal haemodynamic signs, accurately predicts women at risk of death or life-threatening complications from postpartum bleeding". This, they analysed, might aid in the earlier identification and management of postpartum hemorrhage. While the conventional threshold is 500 mL, the researchers suggest that even a lower volume of blood loss such as 300 mL or lower should trigger early treatment, especially when related signs are present.
PPH, or excessive bleeding after childbirth, remains a leading cause of maternal mortality worldwide. In 2023, out of an estimated 260,000 maternal fatalities, around 45,000 were due to PPH.
Although there are established methods for preventing, diagnosing and treating PPH, the application of these evidence-based practices has been sluggish.
The guidelines are intended to inform the development of relevant national and sub-national health policies, clinical guidelines and programmatic guides.
These consolidated guidelines include a total of 51 recommendations for the prevention, diagnosis, treatment, supportive care and health system interventions for PPH.
The guidelines recommend the immediate deployment of the E-MOTIVE bundle of actions once PPH has been diagnosed. This includes:
• Massage of the uterus
• Oxytocic drugs to stimulate contractions
• Tranexamic acid to reduce bleeding
• Intravenous fluids
• Vaginal and genital tract examination and
• Escalation of care if bleeding persists.
In rare cases where bleeding persists, the guidelines suggest effective measures like surgery or blood transfusion to safely stabilise a woman's condition until additional treatment can be administered.
The guidelines were accompanied by a suite of training and implementation resources, developed with partners including United Nations Population Fund. These tools will be useful for frontline health workers, national-level guides for introducing new practices and simulation-based training to strengthen emergency response.
The guidelines are designed to "maximise impact where the burden is highest and resources are most limited — helping ensure more women survive childbirth and can return home safely to their families,” said Jeremy Farrar, assistant director-general for health promotion and sisease prevention and care.
The consolidated document is the first set of guidelines to focus on PPH, are a crucial step in the implementation of the Global roadmap to combat postpartum haemorrhage between 2023 and 2030.
In October 2023, WHO and several partners launched the Roadmap to Combat Postpartum Hemorrhage between 2023 and 2030 — a strategy to galvanise action across PPH research, norms, implementation and advocacy.
The world is not on track to meet the Sustainable Development Goal 3 (Good Health and Well-Being) target of a global maternal mortality ratio below 70 per 100,000 live births by 2030. New insights into the causes of death are essential to speed up advancements.
From this year onward, October 5 would be marked as World PPH Day, sending a clear message that no woman should die from preventable PPH. Efforts to prevent and reduce morbidity and mortality caused by PPH can help address the profound inequities in maternal health globally.